Primary health care nurses’ management practices of common mental health conditions in KwaZulu-Natal, South Africa

Abstract

BackgroundPsychiatric conditions contribute to 13% of the global burden of diseases and account for one third of years lost because of disability (YLD). Despite the high prevalence of mental health problems, primary health care (PHC) services remain ineffective in managing patients with mental health conditions.ObjectivesThe aim of the study was to determine the practices of PHC nurses in the management of psychiatric patients in primary health care clinics in one of the rural districts in South Africa.MethodA survey was conducted amongst nurses working in several PHC clinics in KwaZulu-Natal (KZN) in order to determine their practices in the management of psychiatric patients. Mixed methods were used to determine the PHC nurses practices in the management of psychiatric patients.ResultsThe findings revealed that in five sites (83.3%) treatments are not reviewed every six months, there were no local protocols on the administration of psychiatric emergency drugs, and none of the study sites provided psychiatric patients with education on their medication and its possible side effects.ConclusionBased on the results of this study it is evident that psychiatric patients at PHC clinics in the district where the study was conducted do not receive quality treatment according to institutional mental health guidelines.

A practice framework to enhance the implementation of the Policy on Integration of Mental Health Care into primary health care in KwaZulu-Natal province

“…Strategies that are used at the PHC clinic to ensure that integration of mental health care into PHC is implemented in KZN province include screening of all patients that come to the PHC clinic for mental illness, fast tracking of mental health care users once they have been assessed and found mentally ill, and chronic management of all patients, including mental health care users, using the PC101 model. Dube and Uys 7 warn that lack of knowledge and skills among PHC nurses are factors that contribute to poor management of mental health care users and further argue that shortage of PHC nurses without a psychiatric nursing science qualification lead to poor quality mental health care. Petersen et al 10 state that despite the release of guidelines, there are gaps in the management of mental health care users at PHC clinics, especially in rural areas, namely, insufficient support for PHC nurses which could lead to poor identification of mental disorders at PHC clinics.…”

“…6 Since the publication of the Policy on Integration of Mental Health Care into PHC, there have been challenges that have been reported. 7,8,9 This includes insufficient support and information to guide PHC nurses on the implementation of the policy and the lack of skills and time to provide quality care. 10,11,12,13 These challenges are affecting the implementation of the Policy on Integration of Mental Health Care into PHC; hence, the study aimed to analyse the implementation of policy with the ultimate aim of developing a practice framework for PHC nurses to improve such implementation in KZN.…”

Challenges affecting the implementation of the Policy on Integration of Mental Health Care into primary healthcare in KwaZulu-Natal province

“…In a PHC clinic, nurses are responsible for the management, administration and counselling of patients (Department of Health 2010:2). Since the publication of the Policy on Integration of Mental Health Care into PHC, there have been many challenges (Burns 2008:1; Dube & Uys 2015:2; Kigozi & Ssebunnya 2009:37). Challenges reported included insufficient support and information to guide PHC-trained nurses on the implementation of the policy, and PHC-trained nurses lacking the necessary skills to provide quality mental healthcare (Awenva et al 2012:184; Petersen et al 2011:4; Williams et al 2008:211).…”

“…Despite the efforts of bringing South African health-related policy development and legislation in line with international trends, there have been many challenges with regard to implementation of policies, including the integration of mental healthcare into primary healthcare (PHC) (Burns 2008:1; Dube & Uys 2015:2; Kigozi & Ssebunnya 2009:37). The Policy on Integration of Mental Health Care into PHC in South Africa was published together with the White Paper for the Transformation of the Health System in South Africa in 1997 (Republic of South Africa 1997).…”

“…In 2013, the National Department of Health in South Africa developed the National Mental Health Policy Framework and Strategic Plan 2013–2020 to guide the implementation of policy framework (Department of Health 2013:1). Many facilities in KwaZulu-Natal (KZN) province have attempted to implement the Policy on Integration of Mental Health Care into PHC, but there are reports of challenges that are facing PHC nurses (Awenva et al 2012:184; Burns 2008:1; Dube & Uys 2015:2; Kigozi & Ssebunnya 2009:37). This study investigated the challenges that are negatively affecting the implementation of the Policy on Integration of Mental Health Care into PHC.…”